| Background and Objective: Peritonitis is a worldwide problem to peritoneal dialysis(PD) patients and the rate of peritonitis is variable in different areas, which is a risk factor for peritoneal dialysis patients’ survival. It is well known that immune system is involved in PD-related peritonitis. In addition, vitamin D3 level has been reported to be primary in the regulation of immune function. But little data is available about its role in peritonitis. Therefore, a study was conducted to investigate the effect of vitamin D3 level in prevention of PD-related peritonitis as well as the survival analysis.Materials and Methods: A retrospective study was conducted, including 140 patients in our hospital kidney disease blood purification center during 2012-2013 years. Patients were divided into 2 groups according to their serum 25-hydroxyvitamin D 3(25[OH] D3) levels. The general data of 140 cases of PD patients, including age, gender, height, weight, history of diabetes, history of hypertension, history of cardiovascular disease, smoking history, and other parameters such as Vitamin D3; use of calcitriol and phosphate binder were also analyzed. From the beginning of the study, clinical data of occurrence of peritonitis as well as patient’s complications were recorded. Application of SPSS 20.0 statistical software package was used for statistical analysis of all data, P<0.05 had significant difference.Results:(1) The prevalence of PD related peritonitis was 11.4% among 140 peritoneal dialysis patients.The prevalence of PD related peritonitis in normal serum 25[OH] D3 level group and low serum 25[OH] D3 level group was 6% vs 17%, which was significant difference(c2=4.263, P=0.036).(2) The level of phosphate and triglyceride in low serum 25[OH] D level group were more higher than that in normal serum 25[OH] D3 level group,while the level of age and calcium were lower than that in non-PAD group with p-value<0.05. Meanwhile, the number of patients using phosphate binder and active vitamin D in low serum 25[OH] D3 level group was lower than that in normal serum 25[OH] D3 level group with p-value<0.05.(3)During follow up period, there were totally 38 patients died, among which 24 patients died in low serum 25[OH] D3 level group while 14 patients died in n normal serum 25[OH] D3 level. The mortality rate in low serum 25[OH] D3 level group was higher than that in normal serum 25[OH] D3 level group(c2=4.029, P=0.045).The infection free surivival days was higher in in normal serum 25[OH] D3 level group than that in low serum 25[OH] D3 level group(t=5.678, P<0.01)(4)There was lower survival rate in low serum 25[OH] D3 level group compared with normal serum 25[OH] D3 level(c2=26.648, P<0.01).Meanwhile, among patients with low serum 25[OH] D3 level, the survival rates were lower in patients with peritonitis than patients with no peritonitis, which is significant different(c2=9.734, P=0.002). Similar trends were also found among patients with cardiovascular events(c2=4.514, P=0.034). For patients with no history of phosphate use and active vitimen D3 use, their survival rates were lower than those with history of phosphate use and vitimen D3 use, which were significant different(c2=14.134, P<0.01; c2=59.185, P<0.01). Meanwhile, patients who were in normal serum 25[OH] D3 level group showed a significantly longer time until a first episode of peritonitis than did patients in low serum 25[OH] D3 level group(c2=4.205, P=0.04).(5) Furthermore, age, serum BUN, phosphate, ipth as well as 25[OH] D3 level were the independent risk factors of mortality for peritoneal dialysis patients by Cox regression model.Conclusions: There was significant deficiency of 25[OH] D3 level in patients with peritonitis. Meanwhile, calcium and phosphate metabolism disorder as well as cardiovascular disease may aggravate their death.To prevent these traditional risk factors, reduction of age of patients, improvement of dialysis adequaqcy, use of phosphate binder as well as control of glucose may contribute to the survival of peritoneal dialysis patients. Furthermore, supplementation of 25[OH] D3 may be helpful to prevent PD related peritonitis. |
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